Bleeding Disorders in Adolescents

Why bleeding disorders are often found in adolescence

Many mild inherited bleeding disorders cause few problems in childhood. The first big bleeding challenge often comes in the teen years:

• the first periods: ACOG notes that around 1 in 5 adolescents with heavy menstrual bleeding has an underlying bleeding disorder, and the proportion is higher among those admitted to hospital for it
• wisdom tooth removal, tonsillectomy or other surgery
• contact sports and injuries

Heavy bleeding is often normalized ("my mom has heavy periods too"), so disorders can go unrecognized for years.

Types of bleeding disorders

Signs to look for

Heavy menstrual bleeding

• periods lasting more than 7 days
• changing a pad or tampon every 1 to 2 hours
• passing clots larger than about 2.5 cm (1 inch)
• needing double protection or waking at night to change
• flooding through clothing or bedding
• heavy bleeding from the very first period
• tiredness, breathlessness or pale skin from anemia

See heavy menstrual bleeding and menorrhagia.

Other bleeding signs

• nosebleeds lasting more than 10 minutes, or needing medical care
• bruises without explanation, larger than a coin, or in unusual places
• bleeding gums with brushing
• prolonged bleeding after cuts, dental work or surgery
• a family member with a bleeding disorder or similar symptoms

Diagnosis

A doctor will take a detailed bleeding history, often using a standardized bleeding score questionnaire, and ask about family history. Tests include:

• complete blood count (CBC): platelet count and hemoglobin
• ferritin: iron stores
• prothrombin time (PT) and activated partial thromboplastin time (aPTT): screen clotting factors
• von Willebrand panel: von Willebrand factor antigen, activity and factor VIII levels
• platelet function testing and specific factor levels if initial tests are normal but suspicion remains

Testing is ideally done when not taking estrogen-containing contraception, which can raise von Willebrand factor levels, and not during acute illness. Normal results may need repeating. A hematologist usually leads the assessment.

Treatment

For heavy periods

• Hormonal treatments: combined hormonal contraceptives, progestin-only options and the levonorgestrel IUD reduce bleeding
• Tranexamic acid: taken during periods, reduces blood loss substantially
• Desmopressin (DDAVP): a nasal spray or injection that releases stored von Willebrand factor in many people with type 1 von Willebrand disease
• Iron: to correct anemia and replenish stores

For bleeding episodes and procedures

• Von Willebrand factor or clotting factor concentrates for serious bleeding or surgery
• Platelet transfusions in some platelet disorders
• Emergency plans with a hematology team before dental work and surgery

For ITP

Many teens with ITP need only observation. Steroids, immunoglobulin or other medicines are used for significant bleeding or very low platelets.

Everyday precautions

• avoid aspirin and NSAIDs such as ibuprofen, which affect platelets, unless advised. Use acetaminophen (paracetamol) for pain
• wear a medical alert bracelet for moderate or severe disorders
• tell dentists and surgeons in advance
• for hemophilia, follow sports and prophylaxis guidance from your treatment center

Living with a bleeding disorder

With diagnosis and a treatment plan, most teenagers live normal lives, attend school and play many sports. Specialist hemophilia treatment centers provide coordinated care, including gynecology, physical therapy and counseling. Testing family members can identify others at risk.

Frequently asked questions

Can heavy periods be a sign of a bleeding disorder?

Yes. Heavy periods since the first period, lasting more than 7 days, or needing pad changes every hour or two can signal a bleeding disorder, most often von Willebrand disease. ACOG recommends screening adolescents with heavy menstrual bleeding.

What is the most common bleeding disorder in teenagers?

Von Willebrand disease is the most common inherited bleeding disorder, affecting about 1 in 100 people. Many people have a mild form and are unaware of it until heavy periods, dental work or surgery reveal it.

How do you test a teenager for a bleeding disorder?

Testing starts with a blood count, iron levels and basic clotting tests (PT and aPTT), followed by a von Willebrand panel and sometimes platelet function tests. Results can fluctuate, so a hematologist may repeat them.

Can teenage girls have hemophilia?

Hemophilia mainly affects males, but female carriers can have low factor levels and symptoms such as heavy periods and bleeding after surgery. Some are classified as having mild hemophilia. Carriers should have their factor levels checked.

What medicines should teens with bleeding disorders avoid?

They should generally avoid aspirin and NSAIDs such as ibuprofen and naproxen, which impair platelet function. Acetaminophen (paracetamol) is usually a safer choice for pain. Always check with the hematology team before starting new medicines or supplements.